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Self-reported memory fails to substitute for objective memory measures
S780
Developing Topics: P4 Posters
patient samples with clinically diagnosed AD (n¼18). For Ab42, tau, and tau/Ab42 ratio measurements with the VITROS AB-42 and VITROS Tau assays, sensitivity was 83%, 83%, and 89%, respectively and specificity was 85%, 90%, and 95%, respectively. Preliminary Analytical Data VITROS AB-42 Assay VITROS Tau Assay Time to first result 36 minutes 36 minutes Limit of Detection (pg/mL) 5 pg/mL 12 pg/mL Intra-assay precision (%CV) 0.9,2.9, 1.1 2.9, 0.1, 1.7 Inter-assay precision (%CV) 2.6, 2.8, 1.2 1.1, 0.4, 0.9 Site to site variability with clinical samples (Deming correlation) R 2 ¼ 0.9557 Slope ¼1.110 n ¼ 46 samples R 2 ¼ 0.9982 Slope ¼ 0.989 n ¼ 46 samples Conclusions: The assays for Ab42 and tau proteins exhibit promising performance toward identifying patients with clinically diagnosed dementia. Automation should make the analysis of these important biomarkers more reliable and routine. P4-347
EFFICACY OF A MULTIDIMENSIONAL HOMEBASED CARE COORDINATION INTERVENTION FOR ELDERS WITH MEMORY DISORDERS: THE MAXIMIZING INDEPENDENCE AT HOME (MIND AT HOME) TRIAL
Quincy Samus1, Deirdre Johnston1, Ed Hess1, Ann Morrison2, Peter Rabins3, Constantine Lyketsos1, Betty Black1, 1Johns Hopkins University, Baltimore, Maryland, United States; 2Copper Ridge Institute, Sykesville, Maryland, United States; 3Johns Hopkins School of Medicine, Baltimore, Maryland, United States. Background: Most people with Alzheimer’s disease and related memory disorders are cared for in the community by informal caregivers, but many are unrecognized and not assessed. Models of care that attend to identification and appropriate treatment at the community level must be a public health priority. This project tested the efficacy of a multidimensional care coordination model to improve quality of care and outcomes for community residing people with memory disorders. Methods: 18-month controlled trial of 303 elders age 70+ with cognitive disorders (265 with dementia; 38 with mild cognitive impairment) living at home in 28 zip codes of north/northwest Baltimore, MD, randomized to receive the care coordination intervention (n¼110) or augmented usual care (n¼193). The intervention team included paraprofessionals specially trained in evidence-based dementia care, a psychiatric nurse, and geriatric psychiatrist. Interventionists implemented a standardized protocol consisting of a multidimensional needs assessment, community resource referrals, memory disorder education, counseling, and problem-solving and were supported by a customized web-based application to monitor care progress. Primary outcomes included unmet needs and time to transfer out of the home. Secondary outcomes were participant quality of life, neuropsychiatric symptoms, and depression. Results: Participants had a wide range of unmet needs. Home and personal safety issues, general medical care, meaningful activities, and legal issues were the most common. The intervention group had a greater decrease in total percent unmet needs from baseline to 18 months relative to the control group (b ¼ -1.51, SE 0.78, p¼0.054), with the most significant reductions in safety (p¼0.021) and legal issues (p¼0.015) domains (pre-specified). Intervention participants were less likely to permanently leave their home or die compared to controls (30.0% vs. 45.6%) and had a significant reduction in time to leaving the home for any reason (p¼0.020). Self-reported quality of life was better in the intervention group at 18 months (p¼0.027). No group differences were found on proxy-rated quality of life, neuropsychiatric symptoms, or depression. Conclusions: A multidimensional home-based care coordination intervention implemented by trained paraprofessionals and overseen by geriatiric clinicians led to improvements in care quality, ability to remain in home, and better self-reported quality of life.
P4-348
SELF-REPORTED MEMORY FAILS TO SUBSTITUTE FOR OBJECTIVE MEMORY MEASURES
James Scanlan, JoAnne Laboff, Emory Hill, Screen, Inc., Seattle, Washington, United States.
Background: Cognitive assessment of geriatric patients is now widely recognized as necessary to improve safety and medication compliance. Physicians prefer cognitive assessment methods that are fast and inexpensive. Doctors sometimes just ask patients to assess their own cognition. How accurate are self-reports of cognitive abilities when they are compared to objective measures obtained by computerized testing? Methods: We examined the relationships between objective memory and executive function measures and three subjective patient questions concerning mental clarity, concentration and memory. 7778 subjects were tested in US medical facilities (6/22/2011-4/15/2012) with the CANS-MCI, a computer-administered cognitive examination designed for the earliest detection of MCI. The sample included normal, mildly impaired and demented patients: age¼67.9 (SD¼15), 59% female. The median test time was 34 minutes, including selfreported depression, pain, cognitive ability, and head injury questions. In a subset, CANS-MCI measures were also validated against more traditional measures administered within an independent full neuropsychological evaluation. Results: Patients self-reporting problems with mental clarity and concentration actually performed better on immediate, delayed and cued recall (all p<.0001, all F>25). Regression found the most powerful predictor of self-reported cognitive symptoms was age, with younger people unexpectedly reporting more symptoms than 65+ patients. Analyses restricted to > 65 yrs. old found that those patients who report problems with their mental clarity and concentration perform better on objective memory tests than do patients who do not report problems. In all age groups, subjective memory symptoms were not significantly correlated with objective memory measures. In the > 65 cohort, the strongest predictors of self-reported cognitive symptoms were depression, pain, and head injury history. Conclusions: Self-reported cognitive problems do not match objective memory measures and may deceive medical professionals, since age, depression and pain all affect cognitive complaints. While the utility of caregiver/family assessment is well-established, asking patients to self-identify memory problems is not. The failure to obtain positive results in this very large data set suggests that clinicians using subjective patient memory concerns as substitutes for objective testing are often misguided. P4-349
SAFETY, COMPLIANCE AND THE EFFECTS ON MEMORY OF 48-WEEK SOUVENAID USE IN MILD ALZHEIMER’S DISEASE: RESULTS FROM THE SOUVENIR II AND OPEN-LABEL EXTENSION STUDY
Philip Scheltens1, Jos Twisk1, Rafael Blesa2, Elio Scarpini3, Christine von Arnim4, Anke Bongers5, John Harrison6, Sophie Swinkels5, Richard Wurtman7, R. L. Wieggers8, Bruno Vellas9, Patrick Kamphuis5, 1 VU University Medical Center, Amsterdam, Netherlands; 2Hospital de la Santa Creu i St. Pau, Barcelona, Spain; 3Ospedale Maggiore Policlinico, IRCCS, University of Milan, Milan, Italy; 4Department of Neurology University of Ulm, Ulm, Germany; 5Nutricia Advanced Medical Nutrition, Danone Research, Centre for Specialised Nutrition, Wageningen, Netherlands; 6Metis Cognition Ltd., Department of Medicine, Imperial College, London, United Kingdom; 7Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States; 8Nutricia Advanced Medical Nutrition, Danone Research Centre for Specialised Nutrition, Wageningen, Netherlands; 9INSERM UMR 1027, Toulouse, France. Background: Synaptic dysfunction is a pathological process involved in the early stages of Alzheimer’s disease (AD). Souvenaid Ò, containing the specific nutrient combination Fortasyn TM Connect 1, is designed to support synapse formation and function in AD. A proof-of-concept Souvenir I study showed that 12-week use of Souvenaid improved memory performance in drug-na€Ive patients with mild AD. The Souvenir II study and the Souvenir II Open-Label Extension (OLE) study were designed to investigate these effects during 48 weeks. (Souvenaid is a registered trademark of N.V. Nutricia. Fortasyn is a trademark of N.V. Nutricia.) Methods: In the 24-week double-blind randomised controlled Souvenir II study (NTR1975), 259 drug-na€Ive patients with mild AD (MMSE 20) were randomised to either
Developing Topics: P4 Posters
patient samples with clinically diagnosed AD (n¼18). For Ab42, tau, and tau/Ab42 ratio measurements with the VITROS AB-42 and VITROS Tau assays, sensitivity was 83%, 83%, and 89%, respectively and specificity was 85%, 90%, and 95%, respectively. Preliminary Analytical Data VITROS AB-42 Assay VITROS Tau Assay Time to first result 36 minutes 36 minutes Limit of Detection (pg/mL) 5 pg/mL 12 pg/mL Intra-assay precision (%CV) 0.9,2.9, 1.1 2.9, 0.1, 1.7 Inter-assay precision (%CV) 2.6, 2.8, 1.2 1.1, 0.4, 0.9 Site to site variability with clinical samples (Deming correlation) R 2 ¼ 0.9557 Slope ¼1.110 n ¼ 46 samples R 2 ¼ 0.9982 Slope ¼ 0.989 n ¼ 46 samples Conclusions: The assays for Ab42 and tau proteins exhibit promising performance toward identifying patients with clinically diagnosed dementia. Automation should make the analysis of these important biomarkers more reliable and routine. P4-347
EFFICACY OF A MULTIDIMENSIONAL HOMEBASED CARE COORDINATION INTERVENTION FOR ELDERS WITH MEMORY DISORDERS: THE MAXIMIZING INDEPENDENCE AT HOME (MIND AT HOME) TRIAL
Quincy Samus1, Deirdre Johnston1, Ed Hess1, Ann Morrison2, Peter Rabins3, Constantine Lyketsos1, Betty Black1, 1Johns Hopkins University, Baltimore, Maryland, United States; 2Copper Ridge Institute, Sykesville, Maryland, United States; 3Johns Hopkins School of Medicine, Baltimore, Maryland, United States. Background: Most people with Alzheimer’s disease and related memory disorders are cared for in the community by informal caregivers, but many are unrecognized and not assessed. Models of care that attend to identification and appropriate treatment at the community level must be a public health priority. This project tested the efficacy of a multidimensional care coordination model to improve quality of care and outcomes for community residing people with memory disorders. Methods: 18-month controlled trial of 303 elders age 70+ with cognitive disorders (265 with dementia; 38 with mild cognitive impairment) living at home in 28 zip codes of north/northwest Baltimore, MD, randomized to receive the care coordination intervention (n¼110) or augmented usual care (n¼193). The intervention team included paraprofessionals specially trained in evidence-based dementia care, a psychiatric nurse, and geriatric psychiatrist. Interventionists implemented a standardized protocol consisting of a multidimensional needs assessment, community resource referrals, memory disorder education, counseling, and problem-solving and were supported by a customized web-based application to monitor care progress. Primary outcomes included unmet needs and time to transfer out of the home. Secondary outcomes were participant quality of life, neuropsychiatric symptoms, and depression. Results: Participants had a wide range of unmet needs. Home and personal safety issues, general medical care, meaningful activities, and legal issues were the most common. The intervention group had a greater decrease in total percent unmet needs from baseline to 18 months relative to the control group (b ¼ -1.51, SE 0.78, p¼0.054), with the most significant reductions in safety (p¼0.021) and legal issues (p¼0.015) domains (pre-specified). Intervention participants were less likely to permanently leave their home or die compared to controls (30.0% vs. 45.6%) and had a significant reduction in time to leaving the home for any reason (p¼0.020). Self-reported quality of life was better in the intervention group at 18 months (p¼0.027). No group differences were found on proxy-rated quality of life, neuropsychiatric symptoms, or depression. Conclusions: A multidimensional home-based care coordination intervention implemented by trained paraprofessionals and overseen by geriatiric clinicians led to improvements in care quality, ability to remain in home, and better self-reported quality of life.
P4-348
SELF-REPORTED MEMORY FAILS TO SUBSTITUTE FOR OBJECTIVE MEMORY MEASURES
James Scanlan, JoAnne Laboff, Emory Hill, Screen, Inc., Seattle, Washington, United States.
Background: Cognitive assessment of geriatric patients is now widely recognized as necessary to improve safety and medication compliance. Physicians prefer cognitive assessment methods that are fast and inexpensive. Doctors sometimes just ask patients to assess their own cognition. How accurate are self-reports of cognitive abilities when they are compared to objective measures obtained by computerized testing? Methods: We examined the relationships between objective memory and executive function measures and three subjective patient questions concerning mental clarity, concentration and memory. 7778 subjects were tested in US medical facilities (6/22/2011-4/15/2012) with the CANS-MCI, a computer-administered cognitive examination designed for the earliest detection of MCI. The sample included normal, mildly impaired and demented patients: age¼67.9 (SD¼15), 59% female. The median test time was 34 minutes, including selfreported depression, pain, cognitive ability, and head injury questions. In a subset, CANS-MCI measures were also validated against more traditional measures administered within an independent full neuropsychological evaluation. Results: Patients self-reporting problems with mental clarity and concentration actually performed better on immediate, delayed and cued recall (all p<.0001, all F>25). Regression found the most powerful predictor of self-reported cognitive symptoms was age, with younger people unexpectedly reporting more symptoms than 65+ patients. Analyses restricted to > 65 yrs. old found that those patients who report problems with their mental clarity and concentration perform better on objective memory tests than do patients who do not report problems. In all age groups, subjective memory symptoms were not significantly correlated with objective memory measures. In the > 65 cohort, the strongest predictors of self-reported cognitive symptoms were depression, pain, and head injury history. Conclusions: Self-reported cognitive problems do not match objective memory measures and may deceive medical professionals, since age, depression and pain all affect cognitive complaints. While the utility of caregiver/family assessment is well-established, asking patients to self-identify memory problems is not. The failure to obtain positive results in this very large data set suggests that clinicians using subjective patient memory concerns as substitutes for objective testing are often misguided. P4-349
SAFETY, COMPLIANCE AND THE EFFECTS ON MEMORY OF 48-WEEK SOUVENAID USE IN MILD ALZHEIMER’S DISEASE: RESULTS FROM THE SOUVENIR II AND OPEN-LABEL EXTENSION STUDY
Philip Scheltens1, Jos Twisk1, Rafael Blesa2, Elio Scarpini3, Christine von Arnim4, Anke Bongers5, John Harrison6, Sophie Swinkels5, Richard Wurtman7, R. L. Wieggers8, Bruno Vellas9, Patrick Kamphuis5, 1 VU University Medical Center, Amsterdam, Netherlands; 2Hospital de la Santa Creu i St. Pau, Barcelona, Spain; 3Ospedale Maggiore Policlinico, IRCCS, University of Milan, Milan, Italy; 4Department of Neurology University of Ulm, Ulm, Germany; 5Nutricia Advanced Medical Nutrition, Danone Research, Centre for Specialised Nutrition, Wageningen, Netherlands; 6Metis Cognition Ltd., Department of Medicine, Imperial College, London, United Kingdom; 7Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States; 8Nutricia Advanced Medical Nutrition, Danone Research Centre for Specialised Nutrition, Wageningen, Netherlands; 9INSERM UMR 1027, Toulouse, France. Background: Synaptic dysfunction is a pathological process involved in the early stages of Alzheimer’s disease (AD). Souvenaid Ò, containing the specific nutrient combination Fortasyn TM Connect 1, is designed to support synapse formation and function in AD. A proof-of-concept Souvenir I study showed that 12-week use of Souvenaid improved memory performance in drug-na€Ive patients with mild AD. The Souvenir II study and the Souvenir II Open-Label Extension (OLE) study were designed to investigate these effects during 48 weeks. (Souvenaid is a registered trademark of N.V. Nutricia. Fortasyn is a trademark of N.V. Nutricia.) Methods: In the 24-week double-blind randomised controlled Souvenir II study (NTR1975), 259 drug-na€Ive patients with mild AD (MMSE 20) were randomised to either